title: Airway management and perioperative concerns in acromegaly patients undergoing endoscopic transsphenoidal surgery for pituitary tumors.
abstract: OBJECTIVE
  Patients with acromegaly present unique challenges to cranial base surgery and anesthesia teams in the perioperative period, especially with regard to airway management. Abnormal airway anatomy may result from soft tissue hypertrophy and bony alterations. Additional perioperative challenges relate to the management of medical comorbidities. We aim to review perioperative airway concerns in acromegalic patients for the skull base surgeon in order to reduce preventable perioperative complications.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care academic institution.
  
  
  METHODS
  Thirty-two acromegaly patients undergoing endoscopic transsphenoidal pituitary surgery.
  
  
  RESULTS
  Videoscopic direct laryngoscopy intubation was required in 7 of 32 patients (21.9%) and fiberoptic intubation in 4 of 32 patients (12.5%). Overall failure rate for first intubation technique used was 12.5% (4/32). Cardiovascular comorbidities (hypertension and conduction abnormalities predominated) were present in 16 of 32 patients (50%), and obstructive sleep apnea, or other respiratory conditions, existed in 12 of 32 patients (37.5%).
  
  
  CONCLUSIONS
  Acromegaly patients present a particular challenge to the endoscopic skull base surgeon. Despite preoperative anesthesia and otolaryngology evaluation, many of these patients will experience an unanticipated airway challenge during intubation. Preoperative preparation and perioperative awareness of anatomic and physiologic abnormalities of acromegalic patients is essential for successful endoscopic surgery in this unique population.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Friedel
authors.forename: Doug R
authors.initials: DR
authors.lastname: Johnston
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singhal
authors.forename: Kenan
authors.initials: K
authors.lastname: Al Khalili
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Farrell
authors.forename: James J
authors.initials: JJ
authors.lastname: Evans
authors.forename: Gurston G
authors.initials: GG
authors.lastname: Nyquist
authors.forename: Marc R
authors.initials: MR
authors.lastname: Rosen
mesh_terms: D000172:Acromegaly / Q000209:etiology*; D000328:Adult; D000368:Aged; D058109:Airway Management / Q000379:methods; D015331:Cohort Studies; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008499:Medical Records; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013101:Sphenoid Sinus; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
keywords: acromegaly; airway management; endoscopic sinus surgery; endoscopic skull base surgery; pituitary; pituitary adenoma; skull base; transsphenoidal